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2 Different types of hypotheses need different types of evidence. This intervention will work for us. (Cartwright 2007) This intervention is harmful. (Osimani, 3:00 p.m.)

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3 Trouble at the top. Randomization does not guarantee homogeneity. (Worrall 2002) Meta-analysis is not all it’s made out to be. (Stegenga 2011) Many RCTs are methodologically flawed. (Hartling 2011, Moher 2008) Many RCTs produce results which are simply false. (Ioannidis 2005)

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4 Hierarchies are crude quality assessment tools. Hierarchies are constrained to ordinal rankings based on few parameters. Better to evaluate evidence with richer scales based on more parameters.

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Quality assessment tools (QATs) A scale or checklist for properties of medical studies Dozens now in use to assess medical evidence As weighting factor in meta-analysis As inclusion criterion for systematic reviews To test relation between quality and other properties of studies

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Jadad QAT 1. Was the study described as randomized?(1 point) method of randomization (1 point) 2. Was the study described as double blind? (1 point) method of blinding (1 point) 3. Was there a description of withdrawals and dropouts? (1 point) 5 points total